[unreadable] About 7-10 % of people are at increased risk of colorectal cancer (CRC) because of family history (FH) of colorectal cancer or polyps, and 25-35% of all CRCs occur in this group. People with a FH of CRC should be screened beginning earlier in life, and the yield is higher than for average risk people. It is not known how often increased risk related to FH is recognized and how often these patients are screened according to widely available guidelines. We plan to assess the prevalence of FH among adults in primary care, whether these patients have been screened according to local guidelines, and barriers to appropriate screening at the patient, provider and system levels. This investigation will be carried out at Harvard Vanguard Medical Associates (HVMA), a multi-specialty group practice with 14 sites in the greater Boston area. HVMA has a defined population of members, complete electronic medical records, and longstanding integration of primary and specialty care. [unreadable] [unreadable] We will survey a sample of 7,000 HVMA members age 35-55 years to measure the prevalence of FH. We estimate that at least 140 will report a FH of CRC, taking into account the reported prevalence of FH and non-response. In a follow-up questionnaire sent to members with a FH of CRC, we will assess attitudes, beliefs, facilitators and barriers to timely identification of increased risk and screening. We will search study patients' electronic medical records to validate patients' reports of screening and to see how often increased risk from FH is recorded. We will convene focus groups of primary care clinicians to elicit provider- and system-level barriers and potential solutions to screening in this subgroup of patients. Information gained about patients, providers and the health care system will be integrated with the assistance of an Advisory Committee of HVMA leaders in order to develop a set of promising interventions. This developmental research will raise hypotheses about the causes of failure to recognize FH and begin timely screening and suggest potential solutions to be tested in subsequent research. [unreadable] [unreadable]